Complications of diabetes are serious and include kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation. Adequate control of diabetes leads to lower risk of complications.
Modern approaches to managing diabetes primarily rely upon dietary and lifestyle management, often combined with regular ongoing blood glucose level monitoring. Diet management allows control and awareness of the types of nutrients entering the digestive system, and hence allows indirectly, significant control over changes in blood glucose levels. Blood glucose monitoring allows verification of these, and closer control, especially important since some symptoms of diabetes are not easy for the patient to notice without actual measurement.
Every patient has different reactions to diet, exercise, and drugs administered. Patients also have different complications or potential complications associated with their disease, often including one or more of: Elevated blood pressure; compromised thyroid function; circulatory abnormalities; stroke; cardiovascular disease; infection; eye health issues including cataracts; and kidney disease. Thus, diabetes management is optimally an individualized management plan, which is continuously updated and revised as patient data relating to diet, exercise, blood glucose, and drug administration changes.
Effective diabetes management therefore requires adhering to a fairly strict diet, exercise, glucose testing and drug (including insulin) administration regimen. But non-adherence to the regimen is commonplace. Kutz S M: Adherence to diabetes regimens: empirical status and clinical applications. Diabetes Educ 16:50-56, 1990; Johnson S B: Methodological issues in diabetes research: measuring adherence. Diabetes Care 15:1658-67, 1992; McNabb W L: Adherence in diabetes: can we define it and can we measure it? Diabetes Care 20:215-18, 1997; Weissberg-Benchell J, Glasgow A M, Tynan W D, Wirtz P, Turek J, Ward J: Adolescent diabetes management and mismanagement. Diabetes care 18:77-82, 1995. Ways to educate patients and increase patient awareness about the importance of strict regimen adherence can have a significant beneficial impact on patient outcomes. Where that educational effort is coupled with close monitoring and advice on glucose testing, diet, exercise and drug administration, the patient outcomes can be improved further.
What is needed is an integrated system of education, monitoring and advising on glucose testing, diet, exercise and drug administration, all in a portable and convenient form for the patient, to maximize system utilization and thus effective disease management.